Friday Five – The week in review

By Simon King

Created 05/18/2017 - 12:00

AstraZeneca becomes a trend-setter in immuno-oncology

Having previously found itself playing catch-up to more advanced competitors in the immuno-oncology market, AstraZeneca turned trend-setter[1] late last week by announcing positive data from the PACIFIC trial, which is assessing the PD-L1 inhibitor Imfinzi in Stage III unresectable non-small-cell lung cancer (NSCLC).

Imfinzi monotherapy, when used as maintenance treatment sequential to chemotherapy and radiotherapy, demonstrated superior progression-free survival versus standard of care irrespective of PD-L1 status, AstraZeneca announced. Positive data not only demonstrates that immuno-oncology has a place in earlier-stage, non-metastatic disease, but AstraZeneca should enjoy a multi-year monopoly in this particular indication, which could be worth between $1 billion and $2 billion in peak sales, forecast analysts. Earlier-than-expected data from the PACIFIC trial also relieves some pressure on AstraZeneca ahead of readout from the MYSTIC study, which is anticipated in the next few months. MYSTIC is assessing both Imfinzi and the combination of Imfinzi with the CTLA-4 inhibitor tremelimumab in first-line NSCLC.

ASCO abstracts drop

Immuno-oncology has also dominated initial discussion of abstracts published ahead of next month's annual ASCO meeting. Incyte was the notable winner, with shares up more than 9 percent in after-hours trading on Wednesday. Positive investor reaction came in response to promising Phase II data for the combination of Incyte's IDO inhibitor epacadostat with a PD-1 inhibitor, showing improved response rates versus PD-1 monotherapy in a number of tumour types. Incyte confirmed earlier this year that it has already chosen to progress this combination into a number of Phase III trials, under collaborations with both Merck & Co. (melanoma, bladder, non-small-cell lung, renal and head and neck cancer) and Bristol-Myers Squibb (non-small-cell lung and head and neck cancer) – ViewPoints: Incyte emerges as clear winner from ASCO abstract dump[2]

Expectation for multi-billion dollar peak sales for the CGRP inhibitor class remains high, despite the relatively small proportion of total migraine patients these injectable biologics will be targeted at. That said, physician feedback indicates these products show meaningful clinical effect in episodic and chronic patients.

One issue could be pricing, as although each of the CGRP candidates – there are a total of four in late-stage development – offers some form of differentiation, these may not prove definitive enough to prevent payers from playing the various candidates off against one another. Erenumab is poised to secure first-to-market status, while galcanezumab is part of a multi-faceted attempt by Eli Lilly to expand both the chronic/episodic and acute migraine markets – and is the subject of our most recent Physician Views poll – Physician Views: Do prescribers hold high hopes for Eli Lilly's one-two strategy in migraine treatment and prevention?[7]

Johnson & Johnson confident it can ride out headwinds

Faced with the threat of biosimilar erosion to Remicade sales and the launch of generic competitors to Zytiga from 2018 onwards, Johnson & Johnson used its biannual pharmaceutical review day to remind investors that it expects strong growth from a number of existing brands over the next four-five years to be flanked by 11 new blockbuster launches from the R&D pipeline – Spotlight On: J&J uses ‘pharma review’ to outline plan to overcoming near-term patent cliff[8]